Reference Request Form

Reference Request Form and Procedure

Employee preference is a minimum of a one to two week notice for a reference request. Employees may deny the request to provide a reference if they feel they do not know the student well enough or if there is not sufficient notice given. Students are required to receive verbal permission from the employee member before submitting this form. The following information is required before requesting a reference form/letter.

Student Name*

Date of Request

Employee name I am requesting a reference from:

This reference is for the following purpose(s):

Application/reference for employment

Admission to another educational institution

All forms of scholarships or honorary awards

Other

(Please check all that apply)

If other, please specify

Criteria Attached

Yes

No

The reference may be given in the following form(s):

Written (Mailed or Emailed)

Oral

(Please check one or both)

I authorize release of any and all information from my education records to the following:

All Prospective employers and educational institutions to which I seek admission, and all organizations considering me for an award or scholarship OR

Only those specific employers, educational institutions or organizations listed on the back page of this form